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This is a surgery
in which a healthy blood vessel (artery or vein)
is used to form a detour (bypass) around a blockage
in a coronary (heart) artery. The new blood vessel
used is called a ‘graft’ and therefore
the procedure is correctly termed as ‘coronary
artery bypass graft’ surgery. The original
blockage in the artery remains as it is, but now
there is adequate blood supply to the heart muscle
beyond the blockage. Today coronary artery bypass
is one of the most frequently performed surgical
procedures. |
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How is it
done? |
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The ‘graft’
used can be either an artery or a vein. However,
these days most advanced heart centers prefer
to use ‘arterial grafts’ since they
have been shown to have a longer life. Studies
performed at the Cleveland Clinic by Dr. Floyd
Loop and others have shown that arterial grafts
remain open even after 20 years of surgery. When
surgery is done only using arteries as grafts
(also called ‘total arterial revascularisation’),
the chances of getting recurrence of angina are
very slim, and in most cases the patient does
not need a second bypass surgery. In the past
‘venous grafts’, usually from a vein
in the leg called saphenous vein were used often,
but they were seen to have an average life of
about ten years, after which the patient needed
a second bypass surgery. |
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The most common artery
used is an artery from your chest called the Left
Internal Mammary artery (LIMA). This artery is
detached from the chest wall and the open end
attached to the coronary artery below the blockage.
The right internal mammary artery (RIMA) can also
be used. However, in diabetic patients and those
with lung problems and obesity we usually do not
use both chest arteries as there are greater chances
of infection. An artery from the arm, known as
the radial artery is also used very commonly. |
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Some surgeons also
use the saphenous vein. In this case, one end
of the vein is stitched onto the large artery
leaving your heart -- the aorta. The other end
of the vein is attached to the coronary artery
below the blockage. |
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What is ‘beating
heart’ surgery? |
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To perform this delicate
surgery the surgeons always used a heart-lung
machine. This machine allowed the heart to be
‘stopped’ for a while to perform the
grafting. However, over the past few years some
of the surgeons also perform the surgery on a
‘beating heart’ and do not use the
heart-lung machine. In this method a device called
‘OCTUPUS’ is used (see accompanying
article) and the surgery is done while the heart
is beating. This method has several advantages
but is technically more demanding. At the Asian
Heart institute almost all surgeries are done
on the beating heart and have resulted in the
patients spending less time in the ICU, less blood
transfusion and complications as well as a shorter
hospital stay. |
